OCT/NOV 2014

FEEDBACK? EMAIL US AT CORPCOMM@AVAILITY.COM

A news magazine for users of the Availity Web Portal

A season of changeNew tools to color (and simplify) your workflow

A SEASON OF CHANGE

The fall season is a time for change and renewal. At Availity, we’re sticking with that theme by releasing new resources to simplify your work life.

CareCalc® is a registered trademark of Blue Cross and Blue Shield of Florida, Inc.

ContactFor newsletter suggestions: corpcomm@availity.comFor customer support: support@availity.com P.O. Box 550857 Jacksonville, FL 32255-0857 1.800.AVAILITY (282.4548)

OCTOBER/NOVEMBER 2014

01

PULSE

CEO NOTE 02

ICD-10 DUAL CODING 03

TOP FIVE WEB PORTAL 04 QUESTIONS & ANSWERS

CLINICAL DOCUMENTATION 07 FOR ICD-10 SUCCESS

SAVING $8.1 BILLION IN 08 ADMINISTRATIVE COSTS

ANTHEM BLUE CROSS AND 09 BLUE SHIELD PROVIDERS IN VIRGINIA

HEADLINES 11

EVENTS & TRAINING 13

Availity Pulse Oct/Nov 2014 1

A SEASON OF CHANGENew tools to color (and simplify) your workflow

The fall season is a time for change and renewal. At Availity, we’re sticking with that theme by releasing new resources to simplify your work life.

Among the recent improvements: a revamped Availity Learning Center, new blog, enhanced Knowledge Base and our latest research study. We’ve also redesigned our release communications to make the information you care about easier to locate. We know your job is challenging, so each of these new resources was designed to be easily accessible, helping you zero in on what’s relevant to you.

Resources at your fingertipsWe think you’re going to love the new Availity Learning Center. Not only does it look new, it runs like new, too! Now it’s easy to search by topic, presenter, popularity and more. The first time you purchase a session, you’ll need to enter a few quick details to set up an account. While you’re looking around, take a minute to check out our upcoming webinars—many offer continuing education credits. Upcoming webinars cover topics like billing for procedures and evaluation and management services, best practices for texting with patients, and value-based payment models.

If you’ve previously purchased sessions through our former learning system, don’t worry, you can still enjoy those, too. Over the next few weeks, we’re uploading transcripts from past events to each users’ account. If you don’t see the transcript you’re looking for by month’s end, drop us a note at training@availity.com. Put our experts to work for you today—check out the new Availity Learning Center.

Insights to help you run a healthy businessWe’ve introduced a blog to deliver fresh insights on topics important to your business. Check out Vital Signs, for news and information on claims and payments, revenue and cost strategies, staff development, management and leadership, ICD-10 and more. We’re planning to publish content that provides news you can use along with information that makes your work-life a bit easier. Drop us a note and tell us what topics, tips or trends you’d like us to post. Or, start a conversation with us on Twitter @Availity. Read more about the new Vital Signs blog in the CEO note on page 2.

Availity Pulse Oct/Nov 2014 2

At Availity, we know that you’re wrestling with a myriad of challenges in your day-to-day work, ranging from things right in your office—like increasing patient collections—to more far-reaching issues in the health care industry, such as ICD-10. We’re working hard to develop products to address these challenges, but our commitment to you doesn’t end there.

We’re continuously looking for ways to make it easier for you to succeed in this challenging environment. We regularly ask for your feedback, and we’re listening. One of the things you’ve told us is that you want to learn about better ways to help run your business. The good news is that we have a lot of talented individuals working here at Availity that want to help. With that in mind, I’m proud to announce the launch of our new blog, Vital Signs. You can access Vital Signs by visiting our website (just click “About us” from the menu and select “Blog”).

So you may be thinking, “Big deal… Availity launched a blog.” But here’s why you should care. Vital Signs will be your best source for perspective, expertise and guidance from Availity professionals and our network of experts who understand your business. Expect to see a mix of tips to run your practice, perspective on trends in the industry, best practices and guidance from top-performing practices, and noteworthy news. Vital Signs will also serve as a platform for extending our conversation with you. We want to interact with you more directly on issues that are important to your business. The more we open up that conversation with you, the better we become at bringing value to our customers. We continue to learn from you and develop

Our best conversations are with you

A NOTE FROM OUR CEO

new ways to simplify and improve the way you do business with us.

The new blog is just one way we’re improving our engagement with you. When we surveyed customers to collect feedback about Eligibility & Benefits enhancements, we not only got an overwhelming response, we funneled that feedback directly to our product development team to start taking action. We also launched a new Availity Learning Center to make it easier for you to access training and launched a new Knowledge Base to simplify how you access support information. I hope you can see that when you speak, we listen!

So join the conversation by subscribing to Vital Signs and following @Availity on Twitter. Or, let us know how we’re doing at support@availity.com.

Respectfully,

Russ Thomas

We want to interact with you more directly on issues that are important to your business.

Availity Pulse Oct/Nov 2014 3

Discussions of ICD-9 and ICD-10 often include mention of the terms “dual processing” and “dual coding.” Different people use these terms to mean different things, but in general, dual coding or processing refers to the use of ICD-9 and ICD-10 codes at the same time. So, when can you expect to use dual coding and processing and when can’t you?

Testing to prepare for ICD-10Dual-coding and dual-processing can be useful tools to prepare for ICD-10 by testing whether you are able to prepare, send, receive and process transactions with ICD-10. However, ICD-10 can be used for testing purposes only before the compliance date; providers and payers cannot use ICD-10 in “live” transactions for dates of service before the ICD-10 compliance date.Dual coding and dual processing after the compliance dateFollowing the ICD-10 compliance date Oct. 1, 2015, providers and payers must use:• ICD-9 in transactions for services provided

before the compliance date• ICD-10 in transactions for services provided

on or after the compliance date

A quick primer to prepare for the October 1, 2015 compliance deadline Source: Centers for Medicaid & Medicare (CMS)

ICD-10:What you need to know about dual coding and dual processing

While providers and payers must be able to use both ICD-9 and ICD-10 codes after the compliance date to accommodate backlogs in claims and other transactions, they will not be able to choose to use either ICD-9 or ICD-10 for a given transaction. The date of service determines whether ICD-9 or ICD-10 should be used.

continued on page 11

Availity Pulse Oct/Nov 2014 4

Your top five questions about the Web Portal, answered

Availity’s Client Services team has heard it allBy: Ashley Cochran, Andrea M. Davis and Nicholas Marino – Availity Client Services team leads

Check out the top five most frequently asked questions our team receives, along with the answers, on the next few pages.

Why did my EDI transmission file get rejected?

There are a number of reasons a file might be rejected, but some quick troubleshooting can help you determine the root cause. Many customers find the following articles helpful when troubleshooting EDI rejection issues:

• Interpreting FAILED Notification Files (in SendFiles Mail Box)

• Interpreting File Acknowledgements• Interpreting Interchange

Acknowledgement Files• Interpreting Functional Group or

Implementation Acknowledgement Data Files

• Interpreting IBR Files• Interpreting EBR Files• Interpreting DPR Files

Availity Pulse Oct/Nov 2014 5

Why can’t I see the results I want? And why is information in the Availity Web Portal different from what I receive on the phone with a payer (for claim status,

eligibility and benefits, etc.)?

Availity displays results data and messages as the payer sends them. The Availity Web Portal is the “pipeline” payers use to display their data to you. In certain situations, if you contact the payer, you may receive different information from what you see in the Web Portal. This is because some payers have multiple systems for storing patient and claim information, and while a payer’s customer service center has access to all of these systems, the payer may be sending data to Availity from only one of those systems (not all), creating the discrepancy.

We understand how frustrating two different sets of information can be for you and our other Web Portal users. If the results you receive are ever unclear, confusing or incomplete, contact Availity Client Services and we’ll do our best to help, since we know the accuracy of this information is important to your business. In some cases, you’ll need to submit a request to your payer(s) so all of their patient and claim systems information is sent to Availity.

Why am I locked out of the Web Portal?

There are a number of reasons you may be unable to log in, including:

1. Incorrect responses to your security questions five consecutive times.

2. It has been 120 days or more since your last login.

3. Your Primary Access Administrator (PAA) has revoked your account. This typically occurs if you have left the organization for a significant amount of time ago and are attempting to use the same log in credentials with a new entity.

4. Your account is not currently associated with an active organization.

To gain access to the Portal after being locked out, contact your PAA for assistance. This is the person responsible for your account with Availity, and has certain administrative rights. You may also contact Availity Client Services.

Who controls my access?For all Availity accounts, there are two primary administrators that can assist you with access and other issues. These are commonly referred to as your PAA and PCA.

• PAAs,orPrimary Access Administrators, function as the link between your organization and Availity

• PCAs,orPrimary Controlling Authorities, have the legal authority to sign agreements for your organization. This is usually a physician or business owner

Availity Pulse Oct/Nov 2014 6

How do I change my password?

If you forget or lose your password, click Help! I can’t log in! from the login screen to set up a new password. You can also change/update your password when you’re logged into the Web Portal. Just follow these steps:

1. Click My Account | My Profile.2. On the My Profile page, click

Change Password. The Verify Current Password page displays.

3. In the Current Password field, type your current password, and then click Continue. The Change your password page displays.

4. Using the password criteria described on the page, choose a new password, and then type it in the Enter new password and Re-enter new password fields.

Note: The page includes a feature that shows you, as you type, whether your new password meets Availity’s security standards. This helps prevent trial and error in creating a password that meets the rules.

5. Click Next. A message displays confirming that Availity has saved your new password.

6. Click Continue. Availity returns you to the My Profile page

Our PAA left. How do I assign someone new as my practice’s PAA?

To replace your team’s designated PAA currently on record with Availity, you’ll need to complete a PCA/PAA Change Request form. Or, contact Availity Client Services at 800.282.4548 to complete the request over the phone. We’ll ask you to verify some basic organizational info.

Note: The current Primary Controlling Authority (PCA) for your organization must sign and date the form; it does not have to be notarized.

To determine the PAA for your organization, click Who Controls My Access? Then, just follow these steps:

1. Display the PCA/PAA Change Request form.2. Complete the appropriate form fields online and

then print the form.3. Make sure the PCA of your organization signs and

dates the form.4. Follow the instructions on the form and submit

it to Availity. Be sure to complete all applicable fields. Fields left blank or incomplete, including the signature field for the PCA, will delay processing.

Note: Once Availity replaces the PAA, the system removes all roles from the former PAA except the Base Role. The new PAA must re-assign roles to the former PAA or revoke the user using Maintain User.

Availity Pulse Oct/Nov 2014 7

The root of all ICD-10 success is rock-solid clinical documentation, so coders and billers have the information needed to code to the level of specificity required for ICD-10. But is your practice ready?

The increased specificity of ICD-10 codes—with more than 69,000 diagnostic codes compared to the ICD-9 set of 13,600—demands a lot from clinical documentation. To ensure your physicians are prepared, consider implementing a clinical documentation improvement (CDI) program. This includes, among other things, regular reviews of documentation prior to the ICD-10 compliance deadline to check for accuracy, completeness and clarity.

Savvy practices are implementing comprehensive clinical documentation improvement programs. Embracing an effective CDI program can:

• Improvethequalityofpatientcaredelivery.• KeepapracticecompliantwithU.S.Centersfor

Medicare and Medicaid Services regulations.• Reduceoreliminatedelaysincoding,and

downstream claim rejections. • Helpdriveefficientworkflowandrevenue.

We’re with you all the wayAs you work to improve your documentation, know that Availity is well prepared for the ICD-10 mandate and we’ll be a trusted partner at your side through the transition and beyond with tools, education, and resources to help you and your team move forward successfully.

How you can keep your practice’s ICD-10 preparations moving at a steady pace

Embracing clinical documentation improvement for ICD-10 success

Clinical documentationImproving the picture of health

The Centers for Medicare & Medicaid

Services requires that health providers document all

medical conditions in a patient’s medical record, including a complete health history of past and present conditions and outcomes. Improving the quality of clinical documentation ensures an accurate, complete picture of the patient’s care and treatment plan while:

• Reducingre-workofclaimsprocessing• Maintainingcompliancewithpayer

regulations and guidelines • Streamliningcoding,billingand

reimbursement

Availity’s educational tools are a great resourceforbuildingyourpractice’sCDIplanandcontinuingyourICD-10 training, while achievingpatientcareandbusinessgoals.

Get in edge on

clinical documentation

success—join us in

Orlando on November 7

for great education,

CEUs and more

Availity Pulse Oct/Nov 2014 8

The health care industry could save an estimated $8.1 billion in administrative costs by adopting electronic transactions, according to The Council for Affordable Quality Healthcare. The organization recently revised its US Healthcare Efficiency Index, a report that dives into trends in electronic administrative transaction adoption and associated savings, and sees big opportunities in automation.

While there’s been good progress in adoption of electronic transactions in recent years, costly manual processes remain, leaving a lot of money on the table—and opportunities for providers to eliminate administrative costs. Most of the potential savings from automation of routine processes would accrue to health care providers and facilities, to the tune of $6.1 billion, according to the report.

The biggest areas of opportunity and cost savings are in six common transactions: claim submission, eligibility and benefits verification, prior authorizations, claim status inquiry, payments and remittance advice. Becker’s Hospital CFO did a nice overview of the report and how the cost savings break down by transaction.

There’s been good uptake of electronic transactions, but challenges in standardization of data, redundant processes and complex reimbursement systems, among other things, likely hinder greater adoption.

At Availity, we’re doing our part to help shore up adoption by enhancing core transactions to make it easier to conduct your claim and payment processes

How we can collectively save $8.1 billion in administrative costs By Mark Martin—Expert Product Manager, Availity

Money on the table

electronically. Here’s how we’re improving these transactions for our customers.

Eligibility and benefitsEligibility and benefits verification presents the greatest opportunity to eliminate cost and save payers and providers $3 per transaction, so what’s the problem? Too many providers are forced to call a payer to determine eligibility and benefits information—a duplicative effort to the electronic process that ultimately undermines the effectiveness of electronic transactions, according to the report. Incomplete results, complex payer programs, increasing patient financial responsibility and continuously evolving medical treatments all contribute to this scenario.

Availity is working with payers to expand results returned, to further reduce or eliminate the need to make a phone call for verification (the cost of doing so, according to the report, is $3.55 for the provider and $3.28 for the payer). We’re also working with providers to ensure information is displayed in a way that makes it quick and easy to find. We’re excited to unveil these enhancements soon.continued on page 11

Availity Pulse Oct/Nov 2014 9

On December 12, 2014, Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. will transition its member eligibility, benefit, claim status and electronic 151s functionality from Point of Care to the Availity Web Portal for providers in Virginia. After December 12, the Availity Web Portal will be your only source to access this valuable information. Additionally, Availity’s secure messaging functionality will replace the Anthem electronic 151 inquiry. Medical management functionality, reports including remittances, and access to prior electronic 151s will remain on Point of Care. Note that access to these functions will be via single sign-on through the Availity Web Portal after the transition date.

To avoid any disruption to accessing information electronically, you’ll need to ensure your team is registered for the Availity Web Portal (if not already) before December 12.

If you’re already registered, you can begin using the Web Portal today. If you have any questions, please contact Availity Client Services toll free at 1-800-282-4548 or via email at virginiapocmigration@availity.com for assistance.

Key provider portal functionality transitioning to Availity

Anthem Blue Cross and Blue Shield providers in Virginia

Tips to get started• Know your Health Plan user ID: Your

Point of Care ID is called Health Plan user ID in the Availity Web Portal. To log in to Point of Care, your Anthem Health Plan User ID must be added to the Availity Web Portal within the Anthem Services Registration by your Primary Access Administrator (PAA). If you do not have a Health Plan user ID, your Point of Care Site Administrator must register you on Point of Care using the Administer Users link under the Administration tab.

• User name must match exactly on your Point of Care and Availity profiles: Your designated PAA needs to connect the Health Plan user ID and Availity ID on the Anthem Services Registration page, and to do that, the user’s name must match exactly in

continued on page 10

Note: Electronic transactions submitted via Anthem’s Enterprise EDI Gateway are unaffected; you may continue to submit all X12 transactions through your current EDI transmission channels. Electronic transactions submitted via Provider Self Service (PSS)—the secure provider website for Anthem HealthKeepers Plus (Medicaid)—are unaffected at this time.

Availity Pulse Oct/Nov 2014 10

both user profiles. If the PAA tries to connect a user’s IDs and the names are not an exact match, a message will appear stating that the action failed. If you are the PAA and receive this message, go to the user’s profile on either Point of Care or Availity to change whichever profile shows incorrect information.

• Users must have their own Health Plan user ID and Availity ID: We would like to remind all Point of Care users of the following: the sharing of User ID and Password information on our secure site is not compliant with the Health Insurance Portability and Accountability Act (HIPAA). Please ensure that all individuals who access our secure portal have their own individual User ID and password for each system, registered under their name and with their own individual contact information. If you have been using an ID passed down from someone else in your organization, or someone who has left your organization, it is time to register for your own Health Plan user ID and Availity ID.

• If you are the Availity PAA or Point of Care Site Administrator, please keep your user lists up to date: Please review your user lists at least quarterly to disable the profiles of any individuals who are no longer employed, and ensure all current employees have the access they need to enable them to use our secure Web portal. Please take a few moments to do this now. (Also, if you are changing roles or leaving your organization, be sure to assign someone in your organization to replace you.)

Already Registered but Forgot Your Password?On the Availity portal login page, click “Help! I can’t log in!”

Note: You must have an email address included in your profile, and must know the answers to the security questions you provided during initial login.

Registered but locked out?If you have an email address included in your profile, follow the “Help! I can’t log in” option. If you do not have an email address included in your profile, your PAA can unlock your access. Make sure the PAA updates your profile to include your email address. If you don’t know who your PAA is, contact 1.800.AVAILITY (282.4548) toll free (Monday – Friday 8 a.m. – 7 p.m. ET).

Unsure if your organization is registered? Call Availity Client Services at 1.800.AVAILITY (282.4548) for registration status of your tax ID.

Features of the Availity Web Portal• Eligibilityandbenefitsinquiry• Claimsstatusinquiry• Claimssubmission• SecureMessaging(comparable

to electronic 151 functionality)• Patientcaresummaries• Carereminders• Membercertificatebooklets• DirectaccesstoPointofCare

via the My Payer Portal link for your existing functionality, such as online remittances, medical management functionality, etc.

Availity Pulse Oct/Nov 2014 11

ICD-10: What you need to know about dual coding and dual processing continued from page 3

When is the ICD-10 compliance date?October 1, 2015 was confirmed at the deadline for health care providers, health plans and health care clearinghouses to transition to ICD-10. The United States Department of Health & Human Services issued

its final rule on July 31, 2014. The new compliance date gave providers and other health care stakeholders, an extra year to prepare their businesses and operations for the transition.

Read how Availity can help you prepare for ICD-10.

Money on the table continued from page 8

Claim submission The strongest area of electronic transaction adoption is claim submission, with 91 percent of providers electing to go the electronic route over paper. Small provider offices tend to be the holdouts, and may need more support to make this transition.

If you are among the 9 percent submitting via paper, the Availity Web Portal provides a no-cost tool to submit claims via web entry to many of the nation’s largest payers. If you are curious what payers you can access in your area, just check our payer list.

Claim statusElectronic claim status inquiries represent another significant opportunity to streamline routine operations.

While most claim status inquiries are occurring electronically, providers still made more than 28 million telephone calls in 2012 at a total cost of $6.00 per call ($2.25 for providers and $3.84 for payers), according to the report.

Availity has a fantastic claim tracking feature in our Revenue Cycle Management product, which is a great story in using technology to reduce manual efforts and increase productivity. Customers can use automated searches to pinpoint claims that need the most attention, including unpaid, delayed and pended claims. They can also discover patterns, problems or delays in full lifecycle displays of individual or batch claims.

Ultimately, claim status is a transparency issue, and we’re exploring new ways to provide greater transparency between providers and payers. We’re testing new tools in specific markets, so stay tuned for more details!

To read the rest of the article and learn where authorizations and payments/remittances fit into the picture, see our new blog.

NameHIPAA ASC X12 Identifier

Description

Claim submission

837 Submitting claims to a health insurer

Eligibility verification

270/271Sending and receiving information about member eligibility and benefits

Prior authorization

278Sending and receiving information about patient referrals and prior authorizations for care

Claim status 276/277Sending and receiving information about the preocessing status of a claim

Claim payment 835 Sending and receiving payment for a claim

Remittance advice

835

Sending and receiving notice of and reasons for payment, adjustment, denial and/or uncovered charges of a medical claim. May accompany payment and is sometimes referred to as an explanation of payment (EOP)

Transactions Studied for the 2013 Index source CAQH

Availity Pulse Oct/Nov 2014 12

Availity delivers collections guidance for providers Availity has released a new ebook to help physician practices and hospitals better manage the complex payment processes associated with both patient-pay and health plan reimbursement cycles. Download “Method to the Madness: 10 Payment Collection Strategies That Work” for free and get best-practice guidance from Availity experts, lessons learned from our most successful customers and leading market research, all in one handy guide.

Check out the infographic adapted from the e-book

HEADLINES

Availity completes second HITRUST certificationAvaility has earned its second Common Security Framework (CSF) certification from the Health Information Trust Alliance (HITRUST). In 2012, Availity was the first health information network to achieve the distinction. The CSF certification assures Availity’s customers that it meets the stringent criteria set by HITRUST, a leading information security benchmark in the health care industry.

WHAT’S NEW

The Availity Web Portal was updated in September and October to enhance your experience and improve functionality.

September updates include:•Newpayers•Unsolicitedmedicalattachments(AmerigroupinTX

only) •Priorauthorizationnumberfieldforprimary

professional claims•EnhancedsecuritychangestotheWebPortal•CancellationofMedicarepayerIDs

October updates include:• Newcredentialingstatusapp(Humana)• Microsoft® Internet Explorer® 7 retirement

• Newclaimhistoryfeatureforremittance viewer (BCBSMN)

• CancellationofMedicarepayerIDs

For more information, review What’s New and Changed.

Availity Pulse Oct/Nov 2014 13

EVENTS

Come see us in Las Vegas at the Medical Group Management Association (MGMA) 2014 Annual Conference

Sunday, Oct. 26–Wednesday, Oct. 29 Visit MGMA’s website for more details

Upcoming webinars from the new Availity Learning Center

November 4Evaluation and mangement, procedure or both? Accurately bill same day surgical services Betsy Nicoletti, $99

Register and view upcoming learning opportunities in the new Availity Learning Center. Check back often, we add new sessions regularly.